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General NPI Number Information
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NPI Number | 1821820010
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Entity Type | Organization
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Legal Business Name | VICTORY NURSING OF SOUTH FLORIDA
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Dates
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Enumeration Date | 08/15/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 624 S MAIN ST STE 4
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City | BELLE GLADE
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State | FL
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Zip | 33430-3916
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Country | US
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Telephone | 561-879-1013
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Fax |
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Provider Business Mailing Address
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Address Line | 965 WEDGWORTH RD
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City | BELLE GLADE
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State | FL
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Zip | 33430-4621
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Country | US
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Telephone | 561-897-1013
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DYNISHA FRESNEDA
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Credential | RN
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Telephone | 561-779-2284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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